In a survey commissioned by Healthy Women, The National Stroke Association and the American College of Emergency Physicians, only 30% of adult women surveyed knew that women are at higher risk for stroke than men. Only 27% of women surveyed could name more than 2 of the six primary stroke symptoms. How would you do?

1.   Sudden numbness or weakness on one side of the face
2.     Sudden numbness or weakness in an arm or leg
3.     Sudden confusion, trouble speaking or understanding speech
4.     Sudden trouble seeing
5.     Sudden trouble walking, dizziness, loss of balance or coordination
6.     Sudden severe headache with no known cause

The common element here is the sudden onset of symptoms. If you experience any of the above symptoms, call 911 or have someone drive you to the emergency room. Women are used to taking care of family members, friends, and even casual acquaintances…remember to take care of yourself!

Depo-Provera injections are given every 3 months for contraception. This is the same synthetic progestin that is in PremPro. Depo-Provera has been a popular birth control option for women that have a hard time remembering to take a pill every morning. However, that convenience comes at a price. The Depo-Provera injections come with a black box warning that they cause bone loss in users. The longer women use the injections, the more bone density they lose…in some cases as much as 15% or more. There are 5 factors that seem to affect how much bone density a woman will lose while using Depo-Provera:

• Calcium intake-Having adequate calcium levels seems to slow the rate of bone loss. 
•  Vitamin D intake-Women with a low vitamin D level (which is very common in these days of sunblock and indoor living) are at much higher risk for bone loss.        
• Smoking-Smoking increases risk of bone loss dramatically.       
• Drinking alcohol- Women who drink tend to lose more bone density while using Depo-Provera
• Body Mass-Overweight women have been shown to lose the least amount of bone density.

After stopping the injections, a woman’s bones will start to rebuild. In the first 8 to 9 years after stopping injections, studies have shown a 15% increase in bone density on average. Some women won’t completely bounce back-usually the women with several of the risk factors listed above- but all of the women in the studies did show some improvement.

Researchers are now recommending monitoring serum vitamin D levels on all women using the Depo-Provera injections. Taking vitamin D supplements can help slow the expected bone loss.

Uterine fibroids are benign fibrous tumors in the uterus that are fed by estrogen. They are extremely common- about 70% of Caucasian women and 80% of African-American women have fibroids by age 50. Most of them don’t cause any symptoms and women are surprised to find they have a fibroid. In many cases though, fibroids can cause heavy bleeding that can lead to anemia and quality-of-life issues. At that point, you would probably consider treatment. There are several treatments for fibroids, depending on the number, size and location of the fibroids, including:

• Hormone therapy: Since fibroids are fed by estrogen, progesterone can be used to counteract your body’s natural estrogen and shrink the fibroid.
• Progestin-releasing IUD: Effective in women with small fibroids, the progestin in the Mirena IUD has been shown to substantially reduce menstrual bleeding. In one study, 85% of all women with menorrhagia treated with a Mirena IUD had their bleeding reduced to normal amounts after 3 months. By 12 months, a full 40% of the women didn’t have periods at all.
• Myomectomy: Surgically removing the fibroid is one option to preserve the uterus while getting rid of the fibroid. It’s moderately effective…in a study of 196 women who had menorrhagia due to fibroids, 68% reported satisfaction with the myomectomy after 73 months. 32% of the women considered the results unsatisfactory. Another report followed 285 women treated with hysteroscopic mymectomy: additional surgery was required for 9.5% of them after 2 years and 26.7% after 8 years.
• Endometrial ablation: In women who are done with childbearing, but who wish to preserve their ovaries and natural hormones, an endometrial ablation is often an effective treatment for small fibroids. One year after the procedure, 95% of women with fibroids have a reduction in bleeding to normal levels; many women have no menstrual bleeding at all.
•  Uterine artery embolization: While UAE appears to be an effective treatment for many women for fibroids, it’s affect on premature ovarian failure, fertility and pregnancy is not clear. Complications of the procedure may lead to a hysterectomy, so if you are adamantly opposed to a hysterectomy, this would not be a good option for you. This procedure works by cutting off the blood supply to the fibroid. It typically requires an overnight stay in the hospital for pain management.
•  Hysterectomy: A woman with large fibroids or with multiple fibroids that haven’t responded to more gentle treatment may require a hysterectomy for definitive treatment. This is a major surgical procedure with the usual accompanying risks. The physician may just take out the uterus, or may take out the uterus and the ovaries. The latter would put you immediately into menopause along with the pesky symptoms and health risks that go with it. This should be the last resort for women as it is the most invasive and can put women at risk for cardiovascular disease and osteoporosis if her hormones are not replenished.

No one answer is right for every woman. Your treatment of fibroids should be personalized to fit your specific medical history, lifestyle, financial situation, and beliefs and comfort level. Talk to your physician about dealing with uterine fibroids. You don’t have to just “live with it”.

About ¼ of all non-pregnant women older than 20 years old have pelvic floor disorders –a weakening of the pelvic muscles and connective tissues of the pelvis. According to the National Health and Nutrition Examination Survey, 82% of women surveyed had insufficient levels of vitamin D. The women with the lowest levels were the ones reporting pelvic floor disorders and urinary incontinence, regardless of age. Higher vitamin D levels seem to maintain muscle and connective tissue health, reducing the pelvic floor dysfunction and urinary incontinence. Also improved by higher vitamin D levels was the risk of fecal incontinence, although the difference was not as drastic as with pelvic floor disorders and urinary incontinence. For minor incontinence and pelvic floor issues, a regimen of specific exercises and vitamin D supplements may be just as effective as medication. Speak to your healthcare provider for more information. [Badalian SS, Rosenbaum PF. Vitamin D and pelvic floor disorders in women: results from the National Health and Nutrition Examination Survey. Obstet Gynecol. 2010;115(4):795-803]

Women over 35 years old are typically less fertile than their younger counterparts, and their cycles can start to become irregular. This makes it hard for women to predict when ovulation occurs and often results in unplanned pregnancies. It’s important to continue some form of birth control until you’ve been period-free for a whole year. There are some risks that are more common in older women than in the under-35 women.  The greatest risk to women over 39 using hormonal contraception is venous thromboembolism or blood clots. The risk is approximately 4 times higher than for adolescents and is almost 8 times higher in obese women over 39. In these higher risk women, progestin-only pills containing levonorgestrel or norgestimate or an IUD are much safer options.You should also avoid birth control pills if you smoke, have hypertension, are diabetic, or have migraine headaches with auras. The pills can put you at risk for heart attacks and stroke. One rumored risk that turned out to be unsubstantiated was the idea that oral contraceptives increase your risk for breast cancer. In fact, several studies have shown no increased risk for women using combination pills or progestin only pills. Birth control pills have also been shown to reduce the risk of ovarian, endometrial and colorectal cancers to varying degrees.The Depo-Provera shot has been linked to bone loss and breast cancer in women, so is not recommended for women over 39 who are typically starting to lose their protective hormones.  Birth control pill use, on the other hand, has been shown to reduce the risk of hip fracture among postmenopausal women by 25% by increasing bone mineral density.Hormonal contraception may also ease hot flushes and other menopausal symptoms. The pills have low doses of hormones and are often an effective way of preventing pregnancy and controlling the occasional hot flush with one prescription.At what age should hormonal contraception be discontinued? The age at which you no longer need birth control will be different for every woman. An elevated FSH can be one sign of menopause, but that level can be artificially depressed by birth control pill use. Having no periods for one year would be a sign you no longer need birth control. Birth control pills are usually safe in healthy women up to 50 years old. Ask your doctor to be sure before you stop birth control.

Your body produces 3 different estrogens: estrone, estradiol and estriol. Estriol (also known as E3) is the weakest of the 3 natural estrogens and was originally thought to have little significance. It has been virtually ignored by the mainstream medical community because it doesn’t have the quick, recognizable effects on the body that the stronger estrogens do. While estradiol (E2) will stop hot flashes within hours after applying to the skin, estriol takes much longer to affect you. However, current research has found that estriol offers a wealth of benefits without the dangers that sometimes accompany the stronger estrogens or the synthetic estrogens (such as Premarin).  Estriol can help relieve menopausal symptoms, protect your bones, rejuvinate vaginal tissue, benefit urinary tract health and correct vaginal dryness. It may also reduce cardiovascular risk and shows great promise in reducing brain lesions in multiple sclerosis patients.Estriol is the estrogen most commonly associated with pregnancy. In fact, during pregnancy levels of estriol are up to 1,000 times higher than normal when compared to non-pregnant levels. Women suffering from multiple sclerosis often see their symptoms get considerably better during pregnancy.But what about the risk of breast cancer? There have been lots of opinions and articles in the media relating estrogen use to increased risk of breast cancer. What they fail to tell  you is the type of estrogen studied. In a study funded by the U.S. Army and performed at the Public Health Institute in Berkeley, CA, researchers compared estriol levels during pregnancy with breast cancer incidence 40 years later. Results of the study showed that of the 15,000 women involved, those with the highest levels of estriol during pregnancy had the lowest incidence of breast cancer later on. Asian and Hispanic women typically have higher levels of estriol than other racial groups and interestingly have the lowest breast cancer rates.Estrogen has also been linked to endometrial cancer in the media. In one investigation, postmenopausal women were given oral estriol with no progesterone for 6 months. Oral estrone or estradiol are not advised because they can increase the risk of blood clots. Giving them unopposed (without progesterone) is not advised because it can increase the risk of endometrial hyperplasia (overgrowth…which can lead to cancer). However, all the study participants showed an improvement of symptoms; there were no strokes or blood clots and no endometrial hyperplasia (confirmed by endometrial biopsy). There were also no breast changes that would indicate a higher risk for breast cancer.Estriol has been shown to be the safest estrogen we can use to replace our body’s natural estrogens; it gives the most benefits with the lowest amount of risk. Ask your physician if estriol may be the right choice for you.

More than 80% of American women use some form of hormonal contraception during their reproductive years. But, do you really know what these hormones can do? Since their introduction in 1960, birth control pills (and the patches, injections, vaginal rings and implants that followed) have helped women in so many other ways besides preventing pregnancy. Some of the benefits that have been discovered with hormonal contraceptive use:

·         Menstrual cycle regulation

·         Treatment of menorrhagia (heavy periods, often with clots)

·         Treatment of dysmenorrhea (painful periods)

·         Stopping periods all together to improve lifestyle

·         Treatment of PMS

·         Prevention of menstrual migraines

·         Decreasing the risk of endometrial, ovarian and colorectal cancer

·         Treatment of acne

·         Treatment of hirsutism (excessive growth of body or facial hair)

·         Improved bone mineral density

·         Treatment of pelvic pain due to endometriosis

Your doctor should look at your lifestyle, medical conditions, and goals for treatment before deciding which method of birth control is right for you. Maybe you have PCOS with painful irregular periods, acne and some extra hair growth…a birth control pill taken continuously (with no placebos) may be just right for you. Or maybe you have an irregular schedule and don’t plan on having children any time soon…an IUD might be much more convenient. Speak to your doctor about your options. Make your birth control multi-task as well as you do!

The usual recommendations are that women over 40 years old get a mammogram every year. While this is a valuable screening tool, it’s not at all comfortable and the image obtained can be hard to read. Advances in mammography technology are changing all that. Many sites are now offering digital mammography. The images are much clearer, often making additional views unnecessary. Along with the digital mammography service, many sites are trying to make the process more comfortable as well. Breast pads are now being offered so you feel less compression and no cold metal plates! The facilities themselves are undergoing change, becoming more like a day spa with artistic interiors and little “goodie bags” being given to patients. One local company is leading the way towards a more comfortable, accurate mammogram experience. The Imaging Center of Idaho offers a friendly and professional staff, the latest technology, a comfortable interior and soft padding on their mammography plates. I had my screening mammogram there recently and did not feel any embarrassment or discomfort at all. I came away with a clean bill of health, my dignity intact and a “goodie bag” filled with breast health information, mints and a pair of pink gardening gloves. It’s time that medical professionals realize that it’s not enough to follow the latest studies and buy the latest equipment. I applaud the movement towards personalizing treatment-Do I feel cared about? Is the staff knowledgeable and concerned with my emotional well-being as well as my physical care? Can the facility get accurate test results the first time and explain them to me? Even though mammograms are not my favorite way to pass the time, do I feel comfortable going back next year? After my experience with digital mammography and with the Imaging Center of Idaho this year, I can answer “yes” to all these questions. I encourage all women to consider digital mammography for their yearly screenings and ask your doctor who they recommend. Facilities are upgrading all over the country and your mammogram doesn’t have to be a horrible experience anymore.

http://www.imagingcenterofidaho.com/
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A small amount of vaginal discharge is completely normal. Glands inside your vagina and cervix make small amounts of fluid that constantly carry old cells out of the vagina. When you ovulate, breastfeed, or are sexually excited, the discharge can get thicker, but the color remains clear or milky and it does not smell bad. There are several conditions that can cause an odor, a change in discharge, and/or itching. See your doctor if you experience any of the following:

• a sudden increase in the amount of discharge
• a change in color or smell of discharge
• irritation, itchiness or burning in or around your vagina
• bloody discharge when you aren’t having your period

What could be causing your symptoms? There could be many causes, but let’s look at some of the more common problems:

1. Yeast Infection- an overgrowth of yeast fungus in the vagina. Usually not sexually transmitted, you’re more likely to get a yeast infection from antibiotic use, pregnancy, hormone imbalance, diabetes, or being hot and sweaty for long periods. You may have a “cottage cheese” looking discharge, itching, burning, and pain during intercourse. Treated with a vaginal creme that is sold over the counter. Most women have the best results with the 7-day treatment. If that doesn’t work, your doctor can prescribe a pill that will get rid of a yeast infection in one to two doses.
2. Bacterial Vaginosis-a bacterial infection treated with antibiotics. Not usually sexually transmitted. You may have a clear or colored discharge that may have a fishy smell, especially after intercourse. Must be treated or it may cause more serious infections in the fallopian tubes or uterus.
3. Trichomoniasis-an infection caused by a protozoan parasite. Usually caught by having unprotected sex with an infected person. Treated with one dose of antibiotics. Signs of trichomoniasis in women include a frothy, yellow-green discharge, strong odor, pain with intercourse, and genital itching.
4. Chlamydia-a sexually transmitted bacterial infection. 3/4 of women with chlamydia will have no symptoms. Some may have abnormal discharge and burning with urination. Treatment usually consists of a single dose of an antibiotic.
5. Gonorrhea-a sexually transmitted bacterial infection. Most women infected with gonorrhea have no symptoms. If you do have symptoms, they can range from burning sensation while urinating, to increased vaginal discharge and bleeding between periods. Treated with antibiotics.

These are the most common causes of vaginal discharge and itching. If you experience problems, your best course of action is to see your doctor to be properly diagnosed and treated. If you are one of the women who gets frequent yeast infections however, and know the symptoms- do try the over the counter remedies first. If that doesn’t work, follow up with your doctor.

Polycystic Ovary Syndrome is a condition in which a woman’s sex hormones are out of balance, causing distressing symptoms and leading to serious health problems. The cause of PCOS is not known, but it affects up to 1 in 10 women and usually appears in the teen years. In PCOS, the ovaries start making more androgens. This may cause you to stop ovulating, get acne, gain weight, and grow extra facial and body hair. Your body also may have a problem using insulin well. This is called insulin resistance and increases your chance of developing diabetes. Because you aren’t ovulating regularly, you can suffer from infertility. PCOS runs in families and your chances of developing PCOS are greater if you have other women in your family with it.

To diagnose PCOS, your physician will rely on many sources of information. Your past medical history can show: family history of PCOS, periods of anovulation and amenorrhea (not having periods), and a pattern of symptoms and complaints. Your physician will do a physical exam looking for signs of PCOS such as extra body/facial hair and high blood pressure. You will probably have some lab tests run checking insulin levels, hormone levels, and LH/FSH levels. These lab tests will also rule out other problems that may be causing your symptoms. Your physician may order a pelvic ultrasound as well, but can’t diagnose PCOS just from the ultrasound. Many women with PCOS don’t have any ovarian cysts and ovarian cysts are found in women that do not have PCOS. The ultrasound is helpful in assessing the extent of the changes in your body.

How is PCOS treated? Your physician will probably start by recommending a heart-healthy diet rich in high fiber, low fat foods. Most women with PCOS benefit from losing weight-even 10 pounds can make a difference. Get 30 minutes of physical activity every day.

There are some medications that can help relieve symptoms as well. Birth control pills are often prescribed to regulate periods, get rid of facial hair and acne, and to prevent endometrial cancer. Spironolactone is used to lower testosterone levels-which will reduce acne and facial hair growth as well. Metformin can be prescribed, as women with PCOS frequently have insulin resistance. Metformin helps control insulin and blood sugar levels, helps you lose weight, and reduces testosterone levels. This lowers your risk for heart disease and diabetes. You may also be given fertility drugs to help you with pregnancy.

Working closely with your physician to control symptoms of PCOS will protect your current and future health, making your symptoms much more manageable.